Intracranial Hemorrhage and a White Blood Cell Count of Almost 1 Million Cells/μL

Abstract

A 2-year-old boy with respiratory difficulty and altered mental status was intubated and transferred to our hospital. Examination revealed fever (39.5°C), hypertension (110/76 mmHg), and sinus tachycardia (140 beats/minute). He appeared pale with abundant petechiae and purpurae; was unresponsive to verbal, tactile, or painful stimuli; and exhibited decerebrate posturing and a “blown” left pupil. Laboratory studies detected profound leukocytosis (white blood cell [WBC] count 966 200 cells/μL) with 93% blasts, anemia (hemoglobin 7.4 g/dL), thrombocytopenia (platelets 42 000/dL), and a prothrombin time of 25.7 seconds (Figure 1, A and B).